DRG Reviewer

Conduct independent MS-DRG and APR-DRG coding and clinical documentation reviews to ensure accurate DRG assignment and reimbursement. Use advanced ICD-10-CM/PCS expertise and professional judgment to detect coding discrepancies, validate diagnoses, and support DRG validation reviews and appeals. Collaborate with the Medical Director on complex cases, prepare audit findings with authoritative references, and ensure compliance with payer contracts and state/federal regulations while meeting quality and productivity standards.